Healthcare Provider Details

I. General information

NPI: 1518922319
Provider Name (Legal Business Name): ROSA AMELIA MARRON-FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12788 W FOREST HILL BLVD SUITE 1001
WELLINGTON FL
33414-4703
US

IV. Provider business mailing address

12788 W FOREST HILL BLVD SUITE 1001
WELLINGTON FL
33414-4703
US

V. Phone/Fax

Practice location:
  • Phone: 561-793-3232
  • Fax: 561-793-0490
Mailing address:
  • Phone: 561-793-3232
  • Fax: 561-793-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0028958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: